Excision level and indication for contralateral neck dissection in hypopharyngeal cancer surgery

Margins of extirpated specimens of hypopharyngeal cancer were examined histopathologically. Residual cancer nest, which is most likely due to directional preponderance of the submucosal lymph flow of the hypopharyngeal cavity, was characteristically demonstrated at the superior margin and in the submucosal layer. We propose that laryngopharyngectomy be done at the extended excision level superiorly at the base of the palatine tonsil and inferiorly at the level of the 2nd thoracic vertebra and with a safety margin of at least 2 cm. The incidence of ipsilateral and contralateral neck metastasis was also histopathologically evaluated from specimens obtained by neck dissection. Contralateral neck metastasis was histopathologically confirmed in more than 30% of the cases examined and showed a difference in incidence related to histological differentiation and T classification. We conclude that bilateral neck dissection is advisable in all cases of hypopharyngeal cancer except for patients with a well-differentiated T2 lesion.